Dynamic Hyperinflation and Mechanical Ventilation

Treating reversible factors like bronchospasm and secretions improves airflow, reduces work of breathing, and enhances oxygenation.

Increasing expiratory time by decreasing the I:E ratio allows more time for exhalation, reducing air trapping and improving respiratory mechanics.

Measuring PEEPi helps assess the degree of dynamic hyperinflation and informs management strategies to optimize ventilation.

<p>Setting exogenous PEEP to about 2/3 of PEEPi improves gas distribution and reduces the work required for inspiratory triggering.</p> Signup and view all the answers

<p>Disconnecting allows spontaneous exhalation, relieving pressure and facilitating breathing before reconnecting to the ventilator.</p> Signup and view all the answers

<p>Bronchospasm increases expiratory resistance, leading to higher PEEP levels.</p> Signup and view all the answers

<p>Impaired elastic recoil, particularly in emphysema, reduces the lungs' ability to expel air, necessitating higher PEEP to maintain adequate ventilation.</p> Signup and view all the answers

<p>Narrowed or kinked endotracheal tubes and inspissated secretions increase expiratory resistance, leading to higher PEEP.</p> Signup and view all the answers

<p>Inadequate expiratory time causes incomplete lung emptying, which increases minute ventilation and therefore requires higher PEEP to optimize inhalation.</p> Signup and view all the answers

<p>An HME filter can increase expiratory resistance due to moisture or bacterial buildup, leading to an elevation in PEEP.</p> Signup and view all the answers

<p>Dynamic hyperinflation occurs when air is trapped in the lungs during expiration, leading to an increase in intrathoracic volume associated with high PEEP levels.</p> Signup and view all the answers

<p>Increased intrathoracic volume raises airway pressures required for a given tidal volume, leading to a higher risk of barotrauma.</p> Signup and view all the answers

<p>Increased intrathoracic pressure decreases venous return and preload, which can result in reduced cardiac output.</p> Signup and view all the answers

<p>High PEEP increases the inspiratory work needed to trigger the ventilator due to heightened intrathoracic pressure.</p> Signup and view all the answers

<p>The risks include lung injury, pneumothorax, and potentially fatal respiratory complications.</p> Signup and view all the answers

<p>Hypotension can occur due to decreased cardiac output from reduced venous return caused by increased intrathoracic pressure.</p> Signup and view all the answers

<p>'Breath stacking' refers to the accumulation of air in the lungs due to inadequate expiration, exacerbated by high PEEP settings.</p> Signup and view all the answers

<p>The expiratory hold maneuver is performed to allow alveolar pressure to equilibrate with airway pressure, providing an accurate measurement of PEEP.</p> Signup and view all the answers

<p>The optimal duration for expiratory circuit occlusion is 3-5 seconds.</p> Signup and view all the answers

<p>During an expiratory hold maneuver, alveolar pressure equilibrates with airway pressure, indicating the level of intrinsic PEEP.</p> Signup and view all the answers

<p>The graph displays pressure, flow, and volume curves; these illustrate the physiological changes during the expiratory breath hold, significant for understanding ventilation mechanics.</p> Signup and view all the answers

<p>Intrinsic PEEP refers to the unintentional positive end-expiratory pressure that remains in the lungs due to incomplete expiration.</p> Signup and view all the answers

<p>The expiratory flow curve does not reach baseline.</p> Signup and view all the answers

<p>There is a drop in blood pressure (hypotension).</p> Signup and view all the answers

<p>They suggest the presence of dynamic hyperinflation.</p> Signup and view all the answers

<p>It indicates possible airway obstruction or bronchospasm.</p> Signup and view all the answers

<p>It shows trapped volume during expiration that was not fully exhaled.</p> Signup and view all the answers

<p>It reflects the presence of air trapping in the lungs.</p> Signup and view all the answers

<p>It allows for observation of prolonged exhalation and change in pressures.</p> Signup and view all the answers

<p>It illustrates the pressure changes over time during breathing.</p> Signup and view all the answers

<p>It indicates an increased risk of respiratory failure due to air trapping.</p> Signup and view all the answers

<p>They can reveal the severity of airway obstruction and effectiveness of ventilation.</p> Signup and view all the answers

<p>Intrinsic PEEP is the positive pressure that remains in the lungs at the end of expiration due to factors hindering expiratory flow; it is significant as it can affect gas exchange and lead to respiratory complications.</p> Signup and view all the answers

<p>Bronchospasm and airway secretions are two causes of intrinsic PEEP, which can impede expiratory flow and increase work of breathing.</p> Signup and view all the answers

<p>Intrinsic PEEP can lead to dynamic hyperinflation, decreased tidal volumes, and increased airway resistance, complicating ventilation efforts.</p> Signup and view all the answers

<p>Management strategies include adjusting ventilator settings, using bronchodilators, suctioning secretions, and addressing underlying conditions.</p> Signup and view all the answers

<p>Intrinsic PEEP arises from dysfunctional expiratory flow within the patient's lungs, while extrinsic PEEP is a controlled pressure applied externally by the ventilator.</p> Signup and view all the answers

<p>Intrinsic PEEP is generated within the respiratory system due to expiratory flow impediments, while extrinsic PEEP is actively applied by the ventilator.</p> Signup and view all the answers

<p>Bronchospasm and mucus plugging are two causes of intrinsic PEEP due to airway obstruction.</p> Signup and view all the answers

<p>Intrinsic PEEP impedes complete expiration, leading to reduced tidal volume during inspiration.</p> Signup and view all the answers

<p>Identifying and addressing the underlying cause of intrinsic PEEP is crucial for effective management.</p> Signup and view all the answers

<p>High intrinsic PEEP can lead to reduced lung compliance, making the lungs stiffer.</p> Signup and view all the answers

<p>Proper management of intrinsic PEEP is essential to prevent lung injuries like barotrauma and volutrauma.</p> Signup and view all the answers

<p>High inspiratory pressures can exacerbate air trapping, leading to increased intrinsic PEEP.</p> Signup and view all the answers

<p>Increased intrinsic PEEP can decrease venous return and cardiac output due to elevated intrathoracic pressure.</p> Signup and view all the answers

<p>Adjusting the inspiratory flow rate, inspiratory time, or tidal volume can help.</p> Signup and view all the answers

<p>Head-of-bed elevation and maneuvers to improve lung recruitment can significantly help.</p> Signup and view all the answers

<p>Neuromuscular blockade may be necessary to reduce the work of breathing in severe cases.</p> Signup and view all the answers

<p>Careful titration is necessary to avoid over-sedation, which can worsen respiratory drive.</p> Signup and view all the answers

<p>NIV provides respiratory support without intubation, potentially reducing elevated intrinsic PEEP.</p> Signup and view all the answers

<p>Higher flow rates can reduce intrinsic PEEP by minimizing the time spent at high lung volumes, while lower flow rates might exacerbate it by prolonging the inspiratory phase.</p> Signup and view all the answers

<p>Shortening inspiratory time can reduce intrinsic PEEP by decreasing the duration of high lung volumes.</p> Signup and view all the answers

<p>Elevating tidal volume can help diminish intrinsic PEEP by ensuring more effective lung emptying and preventing trapped air.</p> Signup and view all the answers

<p>Intrinsic PEEP is a non-dependent pressure within the lungs due to delayed exhalation, and it increases the work of breathing for the patient.</p> Signup and view all the answers

<p>Factors like airway resistance, lung compliance, and respiratory rate greatly affect the levels of intrinsic PEEP generated.</p> Signup and view all the answers